Pratt, Henry rrO O
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! CEM �T� R�'
� A �TE'RY ANI-D CREMATORIUM
ROAD, Q(jjENS6
(518) 745.4476 URY� NEW YORK 17804
(5l8) 745'•4477
Funeral Director
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Crematl.on Ca3eI Ziq
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Tom of Queens"
Pine Vn w Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium. (518)745-4477 '
Audwrizedon to Cremate
The undersigned requests and au tortaes Pine View Cremabrium,In a000rdanoe with end vA*d to Its Rules and Raguletbns to
cremate the remains at
Henry Ira Pratt M
(Norm) (Sect)
6. Delaware Ave. Hudson Falls NY 12839-
(Streat) (CNy) (81819) (7JP Code)
vtto died on day of 05/01/2009 20_
at Residence Hudson Falls NY
(Place) (Address)
Name and address d neerast IM%rele W or name of person aulttorb*V aerrtadort:
Kay Fischer 26 First Street, Glens Falls
( ) (mess)
ReiationsIV to the deCeeaed Daughter
Nameot Funeral Horne Carleton Funeral Home, Inc.
IMPORTANT:
l rep am that to the beet of my lawwledge,the deoeesed(tm)or Qm no)pacemaker,deftdialar,be", y per,pmer
oeil,radioactive implertt or radbacom devba In his or her body.(Clyde One)
1 cenly titan I have U power and sutitortmdon to arrange for the cremali4n of the remains and to dkW the disposition of the
cremated fvam*ts,that arty personal poseeesbtts have althar been rantonred or may be deft nyed,and agree to pr 11" defend and
Wm hantNeea Pbte View Crametarium from arty and aN dsims and demands for bee a dsmspes which maybe made ago! gift"
by reason d a corrected wNh ttts cremation of add remains as dbected,whedw such cM, ar datrrsrtds are or era not whoNy
groundims,false or*aud�rAertt/.
_—h Main Street, Hudson Falls, NY
(Address)
26 First St,Glens Falls
jignmme end Address of or Legal Representative)
Signed on this date:
r
Dlepoeltim al Cremated Remaire
I hereby diract Pine View Crematorh,m to dispose of the cremated remains as follows:.
Mail to
Other arrangements'Plesae epadfy:
tf pulverkgion of cremaled remains is reguealad,check here XX
Reviskrt:April 18,2007